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Health Care Professionals: At the Hospital

Recognize that their infant is unique and irreplaceable. No matter the age of the baby, it is important to realize that parental bonding begins long before birth and that a newborn is already very much a part of his/her family.

Reassure the parents that their expression of grief and the intense feelings associate with it are normal. Grief is not proportional to the size of the person who dies.

Be real; share feelings of distress and sadness with the parents. These are not unprofessional behaviors. Parents greatly appreciate caring physicians, nurses or other health care workers who express their feelings.

Don't rationalize the loss with comments such as "You can have other babies" or "You have other children at home."

Do say "I'm sorry", "This must be so hard" or "How can I help?"

For babies that die at, or shortly after birth, develop a system to flag the mother's room so that everyone on staff can be aware of what has happened. (Perhaps a special sticker or magnet that can be placed on the outside of the hospital room door.)

Let parents know they may take their time.

There will be many decisions to make, but nothing needs to be decided immediately. There is no rehearsal when a baby dies. The moment passes and is gone forever. Families need to be comfortable with the decisions they make. Encourage the parents to see their baby

There are often fears about death and the baby's appearance. You can help set aside these fears by describing gently and honestly how their baby looks.

Suggest that they hold and touch their infant and have some private time alone to say good-bye in an unhurried fashion. Parents who have taken the time to say good-bye in person seem to have an easier and more manageable grief. Holding their baby may prevent a lot of future regrets. Parents who have declined this offer have expressed deep and long lasting guilt and remorse. If they don't want to hold their baby immediately, give them some time and make the offer again. (Even if this means having a staff member make a trip to the morgue)

Wrap the baby in a clean, warm baby blanket. It will show that you cared enough to handle their child tenderly and with respect.

If the baby died at, or shortly after birth, encourage the parents to name their baby and use the name when referring to the child. A name provides an identity, a means of talking about his little person and can help facilitate the grieving process. If the family chooses not to name their baby, be careful to always refer to the child by the appropriate sex.

Emergency Room Personnel: Please be aware of any local county coroner protocols concerning deaths that require investigation.

Take Pictures

Most hospitals try to routinely photograph infants who die. Even if the family chooses not to see their baby; these pictures should be kept in their file should they change their minds. Suggestions:

Take more than one picture.

If possible use a camera using negatives. The pictures will maintain their integrity and it will be easier to obtain quality copies.

Take some with the baby wrapped in blanket, some with the baby unwrapped (if possible), some with the parents holding the baby.

Be sensitive to lighting and think about how the baby can look its best.

For most parents, these pictures will be a cherished, permanent and tangible memory of their child.

Momentos

If these items are not offered to the family, let them know that they may ask for them:

Pictures

The blanket that wrapped their baby

A lock of hair

Certificates: birth, death, baptismal

Handprints/footprints

Hospital name band and name card

Information

The parents will probably have a lot of questions. Be approachable and accessible to them - both in the hospital and afterwards. Grieving parents may need to ask the same questions over and over again before they are able to fully understand what has happened.

Please be patient and realize that most of the parent's energy is directed toward coping and they may be functioning at a minimal level.

Some parents may not know what to ask, or what information may be helpful to them in the days and weeks ahead. Your experience and expertise will be invaluable. Consider sharing some of the choices other parents have made. Most importantly, assure the family that you will be available to answer any questions that may come up at a later date.

Teach parents about the grief process

Give the parents anticipatory guidance regarding what they might experience during the period of acute grief; somatic complaints, feelings of unreality, loneliness, depression, guilt, anger, irritability, loss of routine patterns, preoccupation with the child that died, insomnia and difficulty with friends and family. Warn parents about sudden and dramatic emotional shifts.

Tell them there may be differences in the style and length of grieving between the mother and the father.

Parents don't forget, but as time passes the pain lessens. Warn them that even when life seems to be back to normal, there may still be some unexpected and painful reminders such as anniversary dates and some holidays.

It's not unusual for parents to continue to experience occasional moments or days of sadness throughout their lives.

Referrals

Offer the parents telephone numbers of mortuaries close to their home. Encourage both parents to be involved in this decision making process. This will be the last thing, as parents, they will ever be able to do for their child.

Provide the names and numbers of support groups for parents who have experienced the death of a child. It may be very difficult for parents to reach out for support at this time.